Search Results (12,888)

Background/Objectives: Although COVID-19 may cause cognitive impairments for up to six months, the long-term effects of mild cases remain unclear. Given their high exposure and critical role in public health, assessing this impact on healthcare workers is essential. Aim: The present study aimed to examine the cognitive and emotional effects of mild COVID-19 in 92 healthcare workers one year after infection. Methods: In total, 50 had experienced mild COVID-19, while 42 had not been infected. Participants completed a neuropsychological assessment evaluating attention, memory, and executive functions, along with self-reported measures of anxiety, depression, post-traumatic stress, occupational stress, and burnout. Results: No significant cognitive differences were observed between the groups. However, both exhibited moderate-to-severe psychological distress, with the COVID-19 group showing higher trait anxiety (p = 0.032). Emotional symptoms were significantly associated with neuropsychological performance—higher burnout (ρ from −0.20 to −0.28, p < 0.05) and stress (ρ from −0.25 to −0.33, p < 0.01) correlated with slower responses and more errors in tasks such as the D2 variation index, TESEN execution speed, Rey–Osterrieth Figure recall, and Digit Span forward span. Conclusions: These findings suggest no long-term cognitive impairment after mild COVID-19 but highlight the substantial emotional toll of the pandemic on healthcare workers. Future research should explore cognitive reserve as a protective factor. Full article

Background/Objectives: The aim of this analysis of data from the multi-year nationwide SARSTer program in Poland was to compare the clinical presentation and course of COVID-19 in the last two infectious seasons. Methods: Clinical data from 719 consecutive patients hospitalized between April 2023 and March 2024 were compared with data from 360 patients hospitalized between 1 April 2024 and 31 March 2025. Results: In the 2023/2024 season, hospitalizations due to COVID-19 occurred primarily between September and January, and in the 2024/2025 season, the majority of hospitalizations occurred between July and November. In the 2024/2025 season, we documented a change in the age structure, with an increasing predominance of hospitalized patients over 70 years of age (68% vs. 60% in 2023/2024), a milder disease manifestation, reflected in a significantly lower percentage of patients with pulmonary lesions (19% vs. 24%), an improvement in the clinical course of the disease, reflected in a halving of the number of hospitalizations, a significantly higher percentage of patients with clinical improvement in subsequent weeks of hospitalization, including those discharged from the hospital within the first week (39% vs. 30%), and a significantly lower mortality rate (4.7% vs. 7.9%), especially among patients over 70 years of age (5.4% vs. 10.4%). This indicates that the trend of a milder disease course initiated by the emergence of the Omicron variant continues. Conclusions: In conclusion, our findings provide real-world clinical evidence of the evolution of the COVID-19 situation in the post-pandemic era. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raced around the world across different populations; there needs to be a consolidated effort to understand the divergence of the epidemiology of SARS-CoV-2. Population-based epidemiological characteristics studies measure the extent of SARS-CoV-2 infection in a country. The current research study was designed to report epidemiological data from Pakistan. For this purpose, 246 SARS-CoV-2-infected patients were included in the study. For SARS-CoV-2 confirmation, viral samples were collected from all the study participants; SARS-CoV-2 infection was confirmed by viral nucleic acid detection using a nucleic acid detection kit. After SARS-CoV-2 confirmation, all the study participants were interviewed for epidemiological data through a detailed questionnaire. The study results showed that the disease ratio was higher between 30 and 59 years (51.21%) of age. The male ratio (55.28%) was higher compared to the female ratio (44.71%). The patients’ illiteracy and low socioeconomic status were 32.52% and 59.75%, respectively. The majority of the patients (97.56%) had cough, smell or taste disturbance (79.67%), or fever (76.42%), and 70.73% had fatigue. For comorbidities, a higher ratio was observed for diabetes (38.61%), hypertension (36.17%), and respiratory disease (16.26%). The vaccination status analysis revealed that 51.21% of patients had not received routine immunizations, and 65.5% were un-vaccinated against SARS-CoV-2. Notably, not a single patient was vaccinated for influenza vaccine. The current research study concluded that SARS-CoV-2 was more prevalent in individuals who were middle aged, male, and had low socio-economic status. The most common symptoms were cough, smell or taste disturbance, and fever. The patients’ vaccination status highlights a critical gap in preventive healthcare and shows the need to strengthen vaccination awareness and accessibility in the population to reduce vulnerability to future outbreaks. Future research should focus on investigating the impact of COVID-19 outcomes on comorbidities such as diabetes and hypertension. Full article

Children with COVID-19 typically experience milder symptoms and lower hospitalization rates, though severe cases do occur. Understanding age-related immune responses is crucial for future preparedness. We characterized immune response dynamics to SARS-CoV-2 in 145 samples from 119 pediatric patients (<18 years) with confirmed infection, assessed at four distinct time points: <14 days, 14 days–3 months, 3–6 months, and 6–12 months post-infection. At infection, patients presented increased activated T-cells, higher levels of exhaustion (i.e., PD-1⁺), lower numbers of unswitched memory B-cells, and increased antibody-secreting cells (ASCs). Both humoral and cellular anti-SARS-CoV-2 responses increased over time (all patients showed measurable responses in the last assessment). Asymptomatic/mildly symptomatic patients (58.6%) showed increased specific cellular responses from infection onwards, along with enriched memory B-cell subsets (but not ASCs), and distinct T-cell activation profiles. Children with severe disease were younger, predominantly boys, displayed altered T/B-cell ratios, and reduced PHA responses when infected. Compared to adolescents, younger children showed lower antibody titers and weaker cellular responses to SARS-CoV-2, possibly underlining the higher prevalence of severe manifestations in younger children. Our study illustrates important age-, gender-, and disease severity-dependent variations in immune responses to SARS-CoV-2, which can be helpful in improving patient management and immunization strategies adjusted to age groups. Full article

Objectives: Sex-based disparities in COVID-19 outcomes are well-documented, with men experiencing greater acute severity and women showing increased vulnerability to post-viral syndromes. However, longitudinal immunometabolic trajectories in vaccinated individuals remain underexplored. In this study, sex-based differences in long-term metabolic, endocrine, renal, cardiovascular, and inflammatory responses were investigated among vaccinated individuals recovering from SARS-CoV-2 infection. Methods: This retrospective single-center cohort study included 426 adults (199 females, 227 males) with PCR-confirmed symptomatic COVID-19 and at least two vaccine doses. Serial assessments were conducted at baseline, 18-, 24-, and 30-month post-infection. Parameters included fasting glucose, HbA1c, lipid profile, thyroid function, renal markers, CRP, D-dimer, fibrinogen, troponin, and hematologic indices. Statistical analyses assessed longitudinal changes and sex-stratified correlations. Results: Fasting glucose and HbA1c levels significantly declined over time, more prominently in males. Glucose correlated with age and BMI only in females. Lipid levels remained largely unchanged, although males had higher baseline triglycerides. Females showed rising TSH levels and persistently lower free T3; males exhibited higher creatinine, urea, and troponin levels throughout. Inflammatory markers declined significantly in both sexes, with males displaying higher CRP and troponin, and females showing sustained fibrinogen elevation and a temporary lymphocyte surge. D-dimer was elevated in females at the 30-month point. Conclusions: Sex-specific physiological recovery patterns were evident among vaccinated COVID-19 survivors. Males exhibited earlier metabolic and cardiac alterations, while females had more persistent endocrine and inflammatory shifts. These findings underscore the need for sex-tailored long-term monitoring strategies prioritizing early metabolic and cardiac screening in men and prolonged immunoendocrine surveillance in women. Full article

Dry eye disease (DED) is a prevalent and disabling condition. Artificial tears are commonly used but often inadequate for moderate-to-severe cases. Secretagogues such as pilocarpine, cevimeline, and diquafosol offer potential alternatives, though their comparative effectiveness remains unclear. To evaluate the safety and efficacy of these secretagogues versus artificial tears in adults with DED, we searched CENTRAL, PubMed, Scopus, LILACS, ClinicalTrials.gov, and WHO ICTRP without language restrictions. Randomized controlled trials (RCTs) comparing secretagogues to artificial tears were eligible. Data extraction and synthesis were conducted using Covidence and the Cochrane RoB 2 tool, and 19 RCTs (n = 2697) were included. Fifteen were analyzed quantitatively; however, only eight trials evaluating diquafosol were suitable for meta-analysis, as data for pilocarpine and cevimeline were insufficient for quantitative synthesis. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42020218407. Diquafosol significantly improved rose bengal staining at 4 weeks and OSDI scores and TBUT in post-cataract patients at 4 and 12 weeks. However, it increased mild adverse events (RR, 1.81; 95% CI, 1.15–2.84). Evidence for pilocarpine and cevimeline was limited. Diquafosol 3% shows greater efficacy than artificial tears in post-cataract DED but with more side effects. Further research is needed for other secretagogues. Full article

Background/Objectives: The coexistence of metabolic syndrome and COVID-19 presents a major challenge for healthcare systems, as individuals with metabolic syndrome are at significantly higher risk of severe disease and poor outcomes. The aim of this study was to assess how metabolic syndrome influences the outcomes of rehabilitation in patients recovering from COVID-19. Methods: This is a prospective observational study conducted at a rehabilitation hospital in Szczecin (Poland). One hundred and forty-six patients with COVID-19 were enrolled. Data on age, gender, BMI, comorbidities, and hospitalization were analyzed. The intervention included a comprehensive post-COVID-19 rehabilitation program. Data were collected using functional tests (6MWT and spirometry), and clinical records were analyzed. Results: Patients with metabolic syndrome had significantly higher BMI (p < 0.001), lower HDL cholesterol (p < 0.001), and higher triglyceride levels (p < 0.001) compared with the group without metabolic syndrome. After rehabilitation, both groups showed significant improvements in 6MWT distance (with MetS p < 0.001; without MetS p < 0.001) and FEV₁% predicted (MetS p = 0.025; without MetS p = 0.021). However, regression analysis shows that age was a significant negative predictor of 6MWT performance in both groups (p < 0.01), whereas hypertension and diabetes predicted worse post-rehabilitation outcomes in the group without MetS. Conclusions: Comprehensive rehabilitation after COVID-19 benefits all patients, regardless of the presence of metabolic syndrome. However, individual clinical factors such as age, hypertension, diabetes, and male gender are crucial to its effectiveness. This highlights the need for individualized rehabilitation programs, especially for patients with metabolic conditions, which can significantly increase the effectiveness of therapeutic interventions. Full article

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, spread rapidly across the globe in 2020, with most countries experiencing two distinct waves of infection. In Brazil, the second wave was marked by the emergence of the P.1 (Gamma) variant, which disproportionately affected younger individuals and was associated with increased mortality. This study aimed to evaluate the epidemiological profile and post mortem histopathological lung findings, correlate them with laboratory results, and compare the first and second waves of COVID-19. To investigate neutrophil extracellular traps (NETs), we performed immunohistochemistry for citrullinated histone H3 (cit-H3) and myeloperoxidase (MPO). Our cohort included patients who died in the intensive care unit (ICU) of a single center in southern Brazil. The study included 42 patients, 24 from the first wave and 18 from the second, who died between March 2020 and August 2021. Laboratory data included complete blood counts and D-dimer levels. Histopathological analyses were conducted using H&E-stained slides and reviewed independently by two blinded pathologists. MPO and cit-H3 immunohistochemistry were performed to evaluate NETs markers. All cases exhibited varying degrees of inflammation and diffuse alveolar damage (DAD), with frequent microvascular thrombi. Neutrophilic infiltration was significantly higher in the second wave. Additionally, cases with intense neutrophilic infiltration showed a stronger association with thrombosis. NETs were identified in 10 cases. No significant correlation was found between histopathological findings, NETs, and laboratory blood count results. The histopathological findings were consistent with those reported globally. The second wave of COVID-19 showed higher neutrophilic infiltrate in the lung tissue. Neutrophils play a key role in the inflammatory response and NET formation might indicate an increased risk of mortality. Further studies can consider NET-targeted therapies as potential strategies. Full article

Background/Objectives: Community-acquired pneumonia (CAP) remains a major cause of hospitalisation and death, particularly among older and frail adults. Although treatment guidelines exist, adherence to empiric antibiotic recommendations is variable. This study examined whether receiving guideline-concordant antibiotics for CAP was associated with better short- and long-term clinical outcomes. Methods: We conducted a retrospective cohort study of adults admitted with radiologically confirmed CAP to a tertiary hospital in Australia from 1 January to 31 December 2023. Patients with hospital-acquired pneumonia or COVID-19 were excluded. Antibiotic concordance was assessed against local guidelines. Propensity score matching (PSM) accounted for 16 covariates including age, comorbidities (Charlson Index), frailty (Hospital Frailty Risk Score), and pneumonia severity (SMART-COP). Primary outcomes were in-hospital, 30-day, and one-year mortality. Secondary outcomes included ICU admission, invasive ventilation, vasopressor use, hospital length of stay, and 30-day readmissions. Results: Of 241 patients, 51.4% received guideline-concordant antibiotics. Mean age was 73.5 years; 50.2% were male; 42.2% had severe pneumonia (SMART-COP ≥ 5); 36.5% were frail. In unadjusted analysis, in-hospital mortality was higher in the concordant group (5.6% vs. 0.9%, p = 0.038). After PSM (n = 105 matched pairs), concordant treatment was associated with significantly lower 30-day mortality (coefficient = –0.12; 95% CI: –0.23 to –0.02; p = 0.018) and there was a non-significant trend towards reduced 1-year mortality (p = 0.058). Other outcomes, including in-hospital mortality, were not significantly different. Conclusions: Guideline-concordant antibiotics were associated with reduced 30-day mortality in CAP. These results support adherence to evidence-based treatment guidelines to improve patient outcomes. Full article

Background: High concentrations of supplemental oxygen (FiO₂ > 0.6) are commonly used to treat acute hypoxemia in critically ill patients. However, the effects of High FiO₂ in patients with COVID-19 remain unclear, particularly regarding its impact on hypoxic pulmonary vasoconstriction (HPV) and ventilation–perfusion (V/Q) mismatch. Objective: This study aims to evaluate whether administering lower concentrations of inspired oxygen (FiO₂ < 0.6) is associated with improved outcomes—namely reduced need for mechanical ventilation and mortality—in patients with COVID-19 and severe pulmonary involvement. Methods: This retrospective observational cohort included 201 patients with confirmed COVID-19. Patients were grouped by mean FiO₂ during the first 24–48 h: High FiO₂ (≥0.60) or Low FiO₂ (<0.60). The primary outcome was the requirement for mechanical ventilation; the secondary outcome was in-hospital mortality. A composite endpoint (mechanical ventilation and in-hospital death) was also evaluated. Analyses included logistic regression and Kaplan–Meier survival with log-rank testing. Results: High FiO₂ (≥0.60) was associated with higher odds of the composite outcome (mechanical ventilation and in-hospital death). In multivariable analysis, Low FiO₂ remained associated with lower odds (adjusted OR 0.18; 95% CI 0.08–0.39; p < 0.001). Unadjusted rates were 43.1% vs. 16.1% for mechanical ventilation and 34.3% vs. 8.1% for in-hospital death (High vs. Low FiO₂; both p < 0.001). Event-free survival favored the Low FiO₂ group (log-rank p < 0.001). The model showed excellent discrimination (AUC 0.96; 95% CI 0.92–0.99). Conclusions: Higher early FiO₂ exposure was associated with worse clinical outcomes in severe COVID-19. These findings are consistent with physiological models in which excess oxygen may attenuate hypoxic pulmonary vasoconstriction and increase shunt/dead space. Prospective studies are warranted to assess causality and refine oxygen targets. Full article

Introduction: Human metapneumovirus (HMPV), though commonly perceived as a pediatric pathogen, significantly impacts adults, yet its role in acute respiratory tract infections (ARTIs) remains underappreciated. The COVID-19 pandemic has reshaped respiratory virus epidemiology and amplified the need for comprehensive differential diagnosis. This study aimed to comprehensively investigate the prevalence, clinical characteristics, and post-COVID-19 trends of HMPV infection in adults and to elucidate its critical role in the differential diagnosis of ARTIs by distinguishing it from other common viral pathogens. Methods: This was a retrospective, multicenter study conducted across six hospitals within the Acibadem Hospitals Group in Istanbul, Turkey. Data were collected from two periods: January 2016 to January 2020 (pre-COVID-19) and January 2021 to September 2023 (post-COVID-19), excluding the peak pandemic phase (March 2020 to May 2021). Respiratory samples (sputum, BAL, nasopharyngeal/nasal/throat swabs) were analyzed using multiplex PCR (Seegene RV12-ACE), with an expanded panel including SARS-CoV-2 in the post-COVID-19 era. Demographic data, comorbidities, symptoms, hospitalization, and ICU admission rates were collected. Results: In the post-COVID-19 period, 2197 positive viral panels were recorded, an increase from 1357 in the pre-COVID period, reflecting enhanced testing. HMPV prevalence reached 9.7% post-COVID-19, making it the fourth most common respiratory virus in adults (8.7% of 644 positive adult tests), following SARS-CoV-2 (26.4%), influenza A (21.3%), and rhinovirus (17.5%). The average age of HMPV-infected adults was 52.14 years (18–90 years); 64% were female. While 52% had no comorbidities, common underlying conditions included hypertension (24%), cancer (12%), and diabetes (10%). Weakness (34%), lower respiratory symptoms (16%), and fever (12%) were frequent. A significant proportion of HMPV patients required hospitalization (34%) and ICU admission (18%), with 40% receiving antibiotics. Despite potential severity, the mortality rate was low (2.8%). No significant difference in severity was observed between HMPV monoinfection and co-infected groups (e.g., with influenza A, rhinovirus, SARS-CoV-2, parainfluenza virus 2). Conclusion: Our findings establish HMPV as a significant and increasingly prevalent respiratory pathogen among adults in Istanbul in the post-COVID-19 era. Its non-specific clinical presentation underscores the critical importance of multiplex PCR for accurate differential diagnosis, enabling appropriate patient management and antimicrobial stewardship. While HMPV can lead to severe outcomes requiring hospitalization and ICU admission, particularly in patients with comorbidities, the overall mortality rate remains low. Given the lack of specific antiviral treatments and vaccines, sustained surveillance and continued research into targeted interventions are crucial. Full article

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term adapted from aviation—to standardize the identification and analysis of severe maternal complications. In addition to MNM, various indices are used to assess both access to and the quality of healthcare services. Materials and Methods: This retrospective study evaluated all pregnant women who presented at Başakşehir Çam and Sakura City Hospital, including postpartum referrals, between May 2020 and May 2023. Given the ongoing COVID-19 pandemic during the study period, data from COVID-19-positive patients were reported separately. All definitions and classifications were based on the standardized WHO MNM criteria. Results: A total of 45,458 births occurred at our institution during the study period. Among the COVID-19-excluded cohort, we identified 223 life-threatening conditions (LTCs), 206 MNM cases, and 17 maternal deaths. The resulting mortality index was 7.62%. The most frequent primary diagnoses included placental invasion anomalies, severe preeclampsia, and uterine atony. The most common interventions among LTC cases were ICU admission, prolonged hospitalization, hysterectomy, and massive transfusion. Conclusions: Although the rates of LTCs, MNM, and maternal mortality (MM) are gradually declining, they remain essential metrics for assessing healthcare quality. This study reveals that, while tertiary centers may report higher-than-global-average indices, there remains a significant gap between current outcomes and ideal targets. Enhancing diagnostic training, optimizing intervention strategies, and implementing robust clinical algorithms are critical steps toward reducing severe maternal morbidity and mortality. Full article

The genetic background influences the outcomes of COVID-19. This study aimed to evaluate the incidence of polymorphisms in genes linked to the RAAS system, cytokine production, and vitamin D on COVID-19 severity, with the goal of gaining a deeper understanding of the genetic etiology related to COVID-19. This study involved 338 COVID-19 patients and employed machine learning methods to identify the genetic variants that most significantly affect COVID-19 severity. The results revealed that polymorphisms in the IL6, IL6R, IL1α, IL1R, IFNγ, TNFα, CRP, VDR, VDBP, and ACE2 genes are the most significant genetic factors influencing COVID-19 prognosis, particularly in terms of the risks of COVID-19 pneumonia, mortality, rehospitalization, and associated mortality. The machine learning methods achieved an AUC of 0.86 for predicting COVID-19 pneumonia, mortality, and mortality related to rehospitalization, as well as an AUC of 0.85 for rehospitalization within the first year. These results confirm the crucial role of genetic background in COVID-19 prognosis, facilitating the identification of patients at increased risk. In summary, this research demonstrates that genetics-driven machine learning models can pinpoint patients at heightened risk by primarily focusing on genetic variants associated with ACE2, inflammation, and vitamin D. Full article

Background/Objectives: Obesity is a major modifier of COVID-19 outcomes, contributing to increased disease severity and complications. This study aimed to assess the impact of obesity on clinical severity, pulmonary involvement, and in-hospital mortality among COVID-19 patients and to identify independent predictors of severe disease. Methods: We conducted a retrospective cohort study of 3005 hospitalized adults with RT-PCR-confirmed COVID-19 between 1 January 2020 and 1 March 2023. Patients were stratified by obesity status (body mass index (BMI) ≥ 30 kg/m²). Clinical, comorbidity, imaging, and laboratory data, as well as vaccination status (vaccinated or unvaccinated), were collected. Multivariate regression and gradient boosting models were used to identify predictors of severe outcomes. Effect estimates are expressed as relative risks (RRs) with 95% confidence intervals (CIs). Results: Obese patients (n = 894) showed significantly higher rates of severe COVID-19 (31.7% vs. 22.4%, p < 0.001) and more extensive lung damage (>50% involvement: 27.9% vs. 22.0%, p < 0.001), with lower admission SpO₂ (92.1 ± 4.0% vs. 94.2 ± 3.2%, p < 0.001). Hypoxemia (SpO₂ < 90%) was more frequent in obese individuals. The relative risk (RR) for severe disease was 1.41 (95% CI 1.25–1.60), and for >50% lung involvement, it was 1.27 (95% CI 1.11–1.45). Age > 65 years was the strongest predictor of mortality, particularly in non-obese patients. Gradient boosting models outperformed logistic regression (AUC = 0.92 vs. 0.87). Conclusions: Obesity independently predicts severe COVID-19 and pulmonary impairment. These findings support obesity-based risk stratification for clinical management and public health interventions. Full article

Proteolysis-targeting chimera (PROTAC) technology has demonstrated remarkable progress in tumor therapy, attributed to its unique capability of catalytically degrading “undruggable” targets. In the context of the ongoing global health threat posed by the Coronavirus Disease 2019 (COVID-19) pandemic, the application scope of PROTAC technology has been gradually extended to the field of antiviral research. Unlike traditional small molecule inhibitors, PROTAC employs an “event-driven” mechanism to achieve ubiquitination-mediated degradation of target proteins. This approach holds great promise in addressing challenges such as drug resistance, targeting host-dependent factors, and high-mutagenic viral proteins. This article provides a comprehensive review of the application progress of PROTAC technology in antiviral therapy, with a particular emphasis on successful cases across a range of viral pathogens, including Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), influenza virus, and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Additionally, it delves into the challenges encountered in this field and ponders future development directions. Through the integration of the latest research findings, this article proposes a dual-target degradation strategy based on the host–pathogen interaction interface. These proposals aim to offer theoretical support for the clinical translation of antiviral PROTACs. Full article